Building a better health service?

While attempting to be positive this will be a Happy New Year, Dr Muiris Houston pokes holes in the HSE National Service Plan 2017, which he warns could easily become a chasm

Are you settled back into a routine as you read this? While it’s great to get some sort of a break over Christmas and the New Year, the return of routine can be helpful at this time of year. That presumes of course the annual flu season hasn’t knocked your schedule for six or your hospital isn’t backed up with trolleys stretching into the car park.

Part of routine is dealing with reality. And the reality of healthcare is reflected in the hard facts of the 2017 National Service Plan ‘Building a Better Health Service’, published by the Minister for Health and the HSE just before Christmas.

Not surprisingly, the plan focuses on some of the key pressure points in our public health services: hospital waiting lists, emergency department crowding and the provision of home care and nursing home packages.

On perennial emergency department crowding, the plan has little to offer. It’s basically the existing €40 million Winter Initiative, which has already failed to stem the tide of rising trolley numbers in emergency departments.

“The €40m made available for the Winter Initiative in 2016 has been rolled into the 2017 funding base and this should (my emphasis) lead to improvements in patient experience times, numbers of patients on trolleys and access to appropriate home care packages,” is what the Department of Health said in a statement.

That must go down as one of the most forlorn and plaintive “shoulds” in the Department’s chequered history.

Completely unrealistic
A projected 1.8 per cent increase in the number of people who will receive home care packages in 2017 is completely unrealistic. Already, some patients and their families who have been approved for a package are being told by local HSE offices that funding is not available to implement the decision. How such a miserly funding increase can meet current demand, let alone satisfy patient need next year, was approved at the highest level is beyond me.

At least HSE Chief Executive Tony O’ Brien was honest when he warned its budget for 2017 may not be sufficient to meet competing demands, including replacing ageing medical equipment and costs of new drugs.

It was a point picked up by Dr Tom Ryan, President of the IHCA, who noted that acute health infrastructure was crumbling, with many hospitals attempting to treat patients with inadequate facilities and equipment that was increasingly obsolete.

He said that it was disappointing that the National Service Plan did not provide funding to address the critical acute hospital and mental health capacity deficits that were preventing consultants and frontline staff from treating patients without delays.

“I am also very concerned that despite promises to address the recruitment and retention of nurses and midwifery staff, no effort is being made to address the hundreds of vacant consultant posts that exist across the country and are having a massive impact on patient care,” Dr Ryan said.

By general consensus, the holding of a walk-in recruitment event for nurses returning home for the festive period — a big part of the service plan announcement — won’t make much of a difference. Indeed, the INMO responded with a 90 per cent in favour ballot for industrial action brought about by ever-growing staffing gaps in the acute hospital system.
Curious development
Does anyone else view the holding back of some of the budget by the Department of Health for allocation during 2017 as a curious development? This was how it was put in the service plan announcement:
“A sum of €36.5 million is being held by the Department of Health for:
• Mental health services — €15m to initiate new developments in 2017.
• Primary care development — €18.5m for service developments including reduced prescription charges for over 70s.
• Social inclusion — €3m to invest in services relating to addiction and marginalised groups.”

Long-term health commentators and cynics (who, moi?) will suspect a Machiavellian motive behind the move to create a potential floating fund of cash beyond the immediate grasp of the HSE. Watch this space.

In truth, there are plenty of minefields ahead. The lack of a clear allocation of funding to meet back pay due to unfulfilled elements of the hospital consultant contract — the subject of a recent legal test case — represents a significant threat to this year’s health budget. Throw in an unexpected global infectious diseases event and existing holes in the service plan will become a chasm.

Did I start this column by suggesting the benefit of routine? Clearly that was written with the remnants of festive cheer clogging up my central nervous system!

Latest spotlights

Poster "Lifetime financial cost of childhood obesity on the island of Ireland" presented at the 6th ASOI Annual Conference

The 2018 meeting was held on the 14th of May 2018 in association with the Division of Population Health Sciences at the Royal College of Surgeons in Ireland. This year the focus was on the environmental determinants of food consumption and obesity.

Professor Kevin P. Balanda from the Institute of Public health was delighted to present a poster on the Lifetime financial cost of childhood obesity on the island of Ireland.

International Men’s Health Week (MHW) will run from Monday 11th until Sunday 17th June 2018. It is celebrated in many European countries, as well as in the USA, Australia, New Zealand and Canada.

The overall aims of MHW are to:

Heighten awareness of preventable health problems for males of all ages

Support men and boys to engage in healthier lifestyle choices / activities

Encourage the early detection and treatment of health difficulties in males.

Everyone is encouraged to work together to do at least one small practical thing to improve their own health and the health of men across the island. People in Ireland are also being asked to do something out of this world.

The Association for the Study of Obesity on the Island of Ireland (ASOI) will hold its 2018 Annual Conference on May 14th 2018 in association with the Division of Population Health Sciences at the Royal College of Surgeons in Ireland. The conference will take in the main campus of the Royal College of Surgeons in Ireland, 123 St Stephens Green, Dublin 2.

This year the focus is on the Environmental determinants of food consumption and obesity. Send your abstract to be in with a chance to win the ASOI Award for best submitted abstract (see abstract submission details below).

Society for Social Medicine Annual Scientific Meeting & European Congress of Epidemiology 2019

The Society for Social Medicine Annual Scientific Meeting (the UK’s leading population health conference) takes place in Glasgow in 2018. It is being organised by colleagues from the University of Glasgow and the wider public health community in Glasgow.

The SSM 62nd Annual Scientific Meeting is a three-day academic and professional conference with a mix of high quality, peer-reviewed oral presentations, posters and workshops and ample opportunity for networking. Two keynote lectures will be delivered by Professor Kate Hunt (the Cochrane Lecture) and Professor Mel Bartley (the Pemberton Lecture). Oral presentations run in parallel and are organised by topics, including Health Inequalities, Health Services Research, Lifecourse, Neighbourhoods & Communities, Mental Health & Wellbeing.

The overall aim of this EU project was to contribute to halting the rise of overweight and obesity in children and adolescents by 2020. JANPA stands for “Joint Action on Nutrition and Physical Activity”.

Considerable work has been done on the healthcare costs of adult obesity. Impacts of childhood obesity, however, are rarely included in such obesity costing studies. More work was necessary to understand the impacts of childhood obesity as well as exploring non-healthcare (societal) costs in more detail. JANPA Work Package 4 starts to fill this gap by “developing the evidence-based economic rationale for action on childhood obesity”.

The technical objectives of Work Package 4 are:

to describe the lifetime impact and cost of childhood obesity

to assess the benefits of reducing childhood obesity by 1% and 5%.

This was attempted in seven European countries.

Professor Kevin Balanda (kevin.balanda@publichealth.ie) led JANP WP4. The JANPA WP4 costing model was implemented in an adaptation of the UKHF’s existing software.

JANPA WP4 was a very challenging project and its final deliverables are now available. In particular, final figures for Ireland and Northern Ireland are presented in Deliverable D4.6.

The Association for the Study of Obesity on the island of Ireland (ASOI) has successfully changed the word for obesity in the Irish language. ‘Otracht’ was previously the Irish term for obesity. The English translation of ‘otracht’ is critical, negative and derogatory.

“Language is important. The words we choose matter” says Dr Jean O’Connell, Chair of ASOI. “People living with certain stigmatised diseases say that coping with the stigma of the disease is harder than coping with the disease itself. We need to change the way that we talk about overweight and obesity, in every language”.

Niamh Arthurs (Public Health and Clinical Nutritionist, ASOI Education role) addressed this concern with Foras Na Gaeilge. They advised Ms Arthurs to bring the case to the translation section of the Oireachtas in Leinster House. Following discussion, they informed the ASOI that the word ‘murtall’ will be used instead of ‘otracht’ in legislation in Ireland and they will also advise European institutions to use the term ‘murtall’ in future. Foras Na Gaeilge also stated that they would recommend general use of the term ‘murtall’.

Ireland’s survival rates for cancer patients have improved significantly – latest figures published by The Lancet

Public Health Alcohol Bill to return to the Oireachtas this week

The Minister for Health, Simon Harris has stressed the importance of taking steps, as a society, to prevent cancer. The Minister was marking World Cancer Day, which takes place every year on the 4th of February.

Minister Harris said “Ireland is making significant strides in cancer control. The latest figures published by The Lancet confirm we are moving up the global rankings and cancer survival rates here have improved significantly. Five-year survival rates for cancer have improved from 44.2% (1994-1998) to 61.1% (2010-2014).

“The National Cancer Strategy 2017-2026 aims to ensure that survival rates in Ireland continue to improve and that, over the lifetime of this Strategy, Irish survival rates will reach the top quartile in Europe. In achieving this we must also ensure that our services meet the needs of those living with and beyond cancer, from diagnosis and treatment to psycho-social support post-treatment. I am delighted to see a focus on improving the quality of life for cancer survivors through World Cancer Day”

The Wellbeing of the Nation 2017

The number of healthy life years one can expect to experience has increased from 66.9 in 2014 to 67.3 in 2015

The unemployment rate has fallen from 9.8% in 2015 to 8.6% in 2016

Participation in sport among those aged 15 years and older has fallen from 47.2% in 2013 to 45% in 2015

The CSO has today (10th January 2018) published The Wellbeing of the Nation. This new publication attempts to address the question how do people feel about their lives as a whole.

Commenting on the data, Statistician Damien Lenihan said: “This publication attempts to measure wellbeing, which is influenced by many factors including the economic conditions of the country, the health of its population, and the educational attainment of its people”.With over 30 indicators across eight areas of society, the key findings of the publication include;

Average household debt has fallen from €93,900 in 2014 to €87,900 in 2015

The percentage of those aged 25 to 64 with third level education has remained constant at 41% between the years 2015 and 2016

The number of homeless people, as measured on Census night increased by 81% between 2011 and 2016 from 3,808 to 6,906 persons

The percentage of adults that think crime is a very serious problem in Ireland has increased from 46% in 2006 to 49% in 2010

Commenting further, Damien Lenihan said: “This publication is a starting point in measuring wellbeing and is an area which will be expanded further in the coming years”.

Cancer in Ireland 1994 - 2015 with estimates for 2015 - 2017: Annual Report of the National Cancer Registry

The National Cancer Registry of Ireland has released its 22nd annual statistical report. This report summarises cancer incidence, mortality and survival in Ireland for the period 1994-2015, and provides projected estimates for incidence for the most recent three-year period: 2015-2017. The cumulative lifetime risk (to age 75 years) of an invasive cancer diagnosis was approximately 1 in 3 for men and 1 in 4 for women. The absolute risk difference between the most and least deprived 20% of the population was highest for pancreatic (+14%), lung (+9%), colon (+8%), oesophageal (+8%), and ovarian cancers (+7%). Age-standardized rates of all invasive cancers (excluding non-melanoma skin cancer (NMSC)) were 26% higher in men than in women. Overall, taking the first recorded invasive cancer (exc. NMSC) for each patient, the proportion of cases presenting as an emergency was 15% (of all cases whose admission type was known). The cancers with the highest proportion of emergency presentation were: pancreas (34%), lung (26%), ovary (24%) and colon (22%). For all cancer types, patients resident in the most deprived areas were more likely to present as an emergency. For all cancers examined, relative differences by deprivation were substantial, with patients from the most deprived group 25%-67% more likely to present as emergencies, depending on the cancer type (54% for all cancers combined). Similar data on cancer in Northern Ireland is available here.